Why She Drinks: Women and Alcohol Abuse

Women's growing predilection for wine has a darker side—and the only way to deal with it is to acknowledge the profound differences between how women and men abuse alcohol.

Author Gabrielle Glaser talks to WSJ's Gary Rosen about the growing problem of alcohol abuse among upper middle-class women and why A.A. is not the solution for most of them. Photo: Getty Images.

By

Gabrielle Glaser

Updated June 21, 2013 9:14 p.m. ET

A few summers ago, I stuffed my car full of the last flattened cardboard boxes from a cross-country move and headed to the recycling depot of my suburban New Jersey town. I pulled up behind a queue of slender women at the wheels of shiny SUVs. Their eyes concealed by giant sunglasses, they hopped from their seats to their open trunks and, one by one, reached for the bags that are the totems of upper-middle-class life: silver ones from Nordstrom, plain ones from Whole Foods. Out poured wine bottles, clanking into the rusted recycling truck.

In Portland, Ore., where I lived for six years, I would watch most Sunday nights as a neighbor deposited two giant Merlot bottles in my recycling bin. Her house was a block away, and she had her own bin—but apparently mine seemed like a more discreet place to stash her empties. In New York's Westchester County, where I had lived previously, women would pass around a flask at dreary school functions. Alcohol and motherhood were intertwined, so much so that after I had my third daughter in the anxious autumn after 9/11, I received bottle after bottle of wine as baby gifts.

The growing female predilection for wine seems at first glance like a harmless indulgence for harried mothers who deserve a break. There are T-shirts with a spilled wineglass that say, "Not so loud, I had book club last night." Nearly 650,000 women follow "Moms Who Need Wine" on Facebook,FB-1.26% and another 131,000 women are fans of the group called "OMG, I So Need a Glass of Wine or I'm Gonna Sell My Kids." The drinking mom has become a cultural trope, from highbrow to pop: Jonathan Franzen's Patty Berglund wanders through the first half of "Freedom" with a ruddy complexion he calls the "Chardonnay Splotch." Wine is so linked to the women of "Real Housewives" that several cast members have introduced their own brands. That's no accident: According to the Wine Institute, an industry trade group, women buy the lion's share of the nearly 800 million gallons of wine sold in the U.S. annually—and they are its primary drinkers.

Indeed, more women are drinking now than at any time in recent history, according to health surveys. In the nine years between 1998 and 2007, the number of women arrested for drunken driving rose 30%, while male arrests dropped more than 7%. Between 1999 and 2008, the number of young women who showed up in emergency rooms for being dangerously intoxicated rose by 52%. The rate for young men, though higher, rose just 9%.

These numbers are not driven solely by young women living it up on spring break. A recent Centers for Disease Control and Prevention study of binge drinking—that is, having four or more drinks for women or five or more for men within two hours—revealed a surprising statistic. While the greatest number, 24%, of binge-drinking women are college-age, 10% of women between 45 and 64 said they binge drink—and so did 3% of women older than 65. The college-age binge drinkers and the senior binge drinkers overdid it with a similar frequency, about three times a month.

Gallup pollsters have repeatedly found that the more educated and well off a woman is, the more likely she is to imbibe. White women are more likely to drink than women of other racial backgrounds, but in the past few decades the percentage of women who classify themselves as regular drinkers has risen across the board. An analysis of the drinking habits of 85,000 Americans in 2002 found that 47% of white women reported being regular drinkers, up from 37% in 1992. The percentage of black women who said they drank regularly rose from 21% to 30%, and the percentage of Hispanic women who said the same grew from 24% to 32%. (American Indian and Asian-American women were not included in the study.)

In one sense, the rising rates of alcohol consumption by women are a sign of parity. But this is one arena in which equal treatment yields unequal outcomes. Women are more vulnerable than men to alcohol's toxic effects. Their bodies have more fat, which retains alcohol, and less water, which dilutes it, so women drinking the same amount as men their size and weight become intoxicated more quickly. Males also have more of the enzyme alcohol dehydrogenase, which breaks down alcohol before it enters the bloodstream. This may be one reason why alcohol-related liver and brain damage appear more quickly in heavy-drinking women than men.

Still, modern women haven't caught up to the drinking habits of America's early settlers, whose only safe beverage was alcohol. Historians estimate that colonial men and women drank about a gallon of low-alcohol beer or hard cider a day. In a collection of 500 recipes that Martha Washington left to her granddaughter, 50 were for boozy drinks, plus a couple of hangover cures.

The growing sales of wine to women can be traced to some clever marketing decisions in the 1960s by California's vintners. Wineries had all but perished during Prohibition, and the beverage was considered the drink of poor immigrants and Skid Row drunks. Americans, accustomed to more straightforward spirits and beer, were slow to warm to wine's complexities.

Wine also felt off-limits to women. It was consumed mostly in restaurants, where waiters offered men the wine list, the first taste and the cork. Strategists saw a growth opportunity in the vast numbers of postwar housewives. "We used to joke that if we could just get a bottle of sherry into the kitchen, we'd be off and running," says Harvey Posert, one of the industry's early promoters.

Vineyards got an unexpected boost from Jacqueline Kennedy, who in 1962 led 56 million viewers on a televised tour of the White House. In the dining room, the camera panned to the elegantly laid table, lingering for a few seconds on the crystal glasses next to each place setting. Few could afford the first lady's designer clothes, but the crystal, manufactured in West Virginia, was a small piece of Camelot glamour that women could own for themselves. It took the Morgantown Glass Co. factory years to fill all the orders.

ENLARGE

Surveys have found that the more educated and well off a woman is, the more likely she is to imbibe.
Photo Illustration by Jana Leon Why She

Getting female buyers for the wine, though, was another challenge. In California, where laws allowed wine to be sold in supermarkets, Robert Mondavi's marketers hired middle-age housewives to stand at in-store tasting booths. The saleswomen offered shoppers sips from bottles that would pair perfectly with what they had planned for dinner. The friendly older women helped turn the younger women into confident consumers.

Women's magazines offered tips on how to order, serve and drink the stuff; McCall's magazine, in 1977, featured wine as essential to an "Anti-Stress Diet." Meanwhile, women in California were beginning to make wine, too, experimenting with tastes and textures that appealed to them.

Today, wine is certainly in American kitchens. It's there for enjoyment, of course, but also as a respectable antidote to modern stress—especially for women.

Some social scientists link the rise in female alcohol consumption to the changing role of women in society. Rick Grucza, an epidemiologist at Washington University School of Medicine in St. Louis who studies alcohol-use disorders, correlates women's drinking to the rise in female college attendance. Others suggest that many women continue unhealthy postcollege drinking patterns in male-dominated industries such as finance and technology. Still others find a link among women who step away from their careers to be at home. "The baby's crying, they're not getting paid, they're bored and anxious—and feel guilty that they're bored and anxious," says Mary Ellen Barnes, a psychologist in Rolling Hills Estates, Calif., who treats many female heavy drinkers. Drinking several tall glasses of wine can make those feelings recede—at least for a few hours.

Does that amount to a drinking problem? Doctors around the world differ. The National Institutes of Alcohol Abuse and Alcoholism and the Department of Health and Human Services say that for American women, anything more than a drink a day is risky. In countries such as France, Italy and Spain, where life expectancy for women is longer, authorities set the safe threshold at double that—and sometimes higher.

Many of the women whom I interviewed said that the strict limits set by American law helped to drive their drinking underground. A few glasses slide into a whole bottle, which becomes an embarrassing habit that needs to be concealed.

As she approached her 50th birthday, Joanna, a Pennsylvania information-technology specialist, grew tired of hiding her 1.5-liter empties from her husband. Joanna (who asked that her name be changed to protect her privacy) began attending meetings of Alcoholics Anonymous at the suggestion of her psychiatrist. In the U.S., the 12-step abstinence- and faith-based program is embraced by the nation's courts, much of the medical establishment, insurance companies and popular culture as a one-size-fits-all approach to harmful drinking.

A.A. was founded in 1935 by two men who believed that alcohol dependence could be tamed by regular attendance at group meetings with other recovering alcoholics. Its doctrine calls for members to tame their egos, abstain from all drinking and acknowledge they are in the grip of a force they can combat only with help from a "higher power.''

It doesn't take an advanced degree in gender studies to realize that this approach—which has worked well for millions of people—may not be perfect for women whose biggest problem is not an excess of ego but a lack of it. Women are twice as likely to suffer from depression and anxiety as men—and are far more likely to medicate those conditions with alcohol.

Many women who drink heavily are also the victims of sexual abuse and have had eating disorders. The idea of being powerless can underscore a woman's sense of vulnerability, researchers say. "Women need to feel powerful, not like victims of something beyond their control," says Dr. Barnes. "It gives women power to feel they themselves can change."

Scientists are continuing to explore the biochemical differences in the way that alcohol affects men and women. Studies show that after drinking, men report feeling more powerful, often overstating their capabilities and accomplishments, while women say that it makes them feel more affectionate, sexy and feminine.

In Europe, Hong Kong and elsewhere in the industrialized world, clinicians treat alcohol-use disorders with a variety of techniques developed in the nearly eight decades since the founding of A.A. (Researchers favor the term "alcohol-use disorder," which encompasses a range of severity, over "alcoholism.") Many combine different behavioral therapies with medications such as naltrexone and topiramate, which help block cravings. Both drugs have proved to be effective in helping patients abstain or moderate. Studies around the world have found that for those who are not severely alcohol-dependent, controlled drinking is possible. Advocates of the 12-step program reject these findings and continue to maintain that abstinence is the only remedy.

For Joanna, wine was a nightly antidote for her pressure-filled job. It also provided a respite from a decade of depression after her parents' deaths.

Joanna tried some coed and women's A.A. meetings, but she never felt comfortable exposing herself to strangers. Her concerns were not unfounded: A.A. members talk about the tendency of old-timers to take sexual advantage of fragile newcomers, an act known as the "Thirteenth Step." Questioned about the sexual abuse of young women by one of its own trustees, the A.A. board's Subcommittee on Vulnerable Members responded in 2009 that it could not do anything to oversee tens of thousands of meetings each day. The public-information officer at A.A.'s central office in New York had no comment.

A.A.'s membership surveys reveal that 12% of members are ordered to attend by the courts. Though most have been charged with drunken driving, some are sex offenders and other felons with violent backgrounds. In Hawaii in 2010, a veteran with a history of violence, ordered by authorities to attend meetings after a stay in a psychiatric hospital, killed a woman he met in A.A. and her 13-year-old daughter before shooting himself.

A.A. views the thousands of meetings that take place each day as the work of autonomous groups, responsible for supervising themselves. A group based on anonymity, board members argued, could not do anything to screen members without undercutting its basic principles.

Joanna searched for new options and found the website of Dr. Barnes and her practice partner Ed Wilson. The two offer five days of intensive personal counseling. The idea is to examine what triggers a woman's drinking and to help her decide how she might design a healthier life. "Most of our female clients slip into harmful drinking in their 40s and 50s, masking the discomfort of fluctuating hormones, the adjustment to an empty nest, the death of parents and other role losses," Dr. Wilson says.

For many such women, the problem is learning how to moderate their drinking rather than stopping completely. Decades of research show that it is possible, Dr. Wilson says, and it has been his practice's experience. Clients visit a family doctor who conducts a physical exam and prescribes naltrexone. Once clients return home, they may follow up with the psychologists by phone for several months.

To Joanna, the treatment, which costs $8,750, offered brevity, privacy and encouraging results. Dr. Wilson said that his practice's 240 clients reported a 70% success rate after six years, having achieved their desired goal of moderation or abstention.

Joanna, who decided it would be easiest to quit booze altogether, hasn't indulged in nearly four years. She credits her therapy and three months of naltrexone, which in some small studies has been shown to reduce alcohol euphoria most effectively in women, as well as meditation, for her success. "It's liberating," she says. "I remember what I read at night now."

Mark Willenbring, a psychiatrist in St. Paul, Minn., and a former director of treatment research at the National Institute of Alcohol Abuse and Alcoholism, believes that the new drugs, along with others in development, will lift the stigma of alcohol-use disorders, much as Prozac changed views of depression.

Notwithstanding the well-publicized trips of celebrities to rehab, fewer than 10% of the estimated 20 million Americans with harmful drinking habits ever receive specialized treatment. That could change, Dr. Willenbring argues, if primary-care doctors were trained to administer antirelapse drugs and counseling to those on the less troubled end of the spectrum.

That would be good news for the many women who have crossed beyond a controlled sipping point but are unable to spend a month in rehab and uncomfortable with the notion of powerlessness.

—Adapted from "Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control," to be published July 2 by Simon & Schuster.

Both Moderation Management which is the only self-help group supportive of people cutting back on their drinking and SMART Recovery, an abstinence-oriented, cognitive behavioral group have memberships of over 50% females. Why? In part because they focus on empowering people to make positive changes in their drinking.

Keeper, Her son Tj was murdered in 2001 by a pedophile who was targeting AA meetings a local small rehabs for teen boys. Krisitne Cass and her 13 year old daughter Saundra were also murdered by a Man she met in AA who was court ordered. Another woman in Michigan was recently killed by a man she me tin AA. The public and AA members have a right to know what s really going on in AA and NA.

ALso it is unconstitutional to sentence someone there for a drunk driving ticket in 25 states. The Public needs to know they have 7 other free options. You can not send a person to a religion for a mental health problem or a behavior. What the heck is going on here. How have they gotten away with this for so long. Thank you for publishing this story here.

It's shocking to me tha AA is portrayed as an out of control organization with sexual offenders as members and that women should be careful before they consider attending meetings. AA has saved countless alcoholics from the bottle both male and female over the last 70 Years and I find this portrayal absurd.

It is very difficult for "civilians" to understand an organization such as AA. The top-down models implied by some of these uninformed comments would kill AA almost instantly. Most alcoholics have an innate hatred of being controlled or ordered about by someone else, particularly when that someone is just a bureaucrat or a doctor, who is not a fellow sufferer. That is why these organizations are staunchly independent, anonymous and rely on shared experience rather than outside authority. It is also why most well run treatment centers only hire fellow sufferers. Trust and understanding are vitally important.

As with any large organization, there are sex offenders, criminals, perverts and people suffering from other addictions, diseases, real or imagined personal failings and traumas in AA. However, for a very large number of AA members, alcohol was not the cause of their other maladies, but, for a time at least, it was a cure for them. Unfortunately, alcoholism is generally thought to be genetically transmitted and often, it only raises its ugly head after long abuse, while the sufferer is trying to medicate the symptoms at least of his life problems. Alcoholism can be likened to an allergy, which strikes back viciously when the body has been tortured by it too much.

For those with other maladies, it is often necessary to treat the alcoholism first in order to successfully examine the underlying maladies. This is doubly hard because, first, alcohol has been seen as the only salvation by the sufferer for an extended time, and, second, unlike almost any other disease, alcohol (or any other drug) causes the sufferer to deny the existence of his addiction, sometimes to his last breath.

I have no medical training but have been a grateful recovering alcoholic for over 26 years.

Mr. Kimble, I attend two or three AA meetings a year. They are comforting, spiritual and uplifting. We're all powerless over some aspect of our lives -- from workaholism, punctuality obsessions, admitting when we can no longer help our kids with math homework because we've not attained their level of proficiency, whatever. For all I know there are chocohalics or popcorn addicts.

One thing I've observed over the years has been AA's change in attitude about not taking prescription drugs. Many alcoholics or heavy drinkers have psychological problems. Seems to me that many of their members are bipolar. Bipolar folks drink when they're depressed to knock out the depression. If you're buzzed the depression doesn't hurt so much. When you're in a manic phase, drinking can add the the 'excitement.'

I note that you say you're a recovering alcoholic. Alcoholics are never "recoverED" You understand the reality that booze ready to bite you in rear if you take another drink. If you do, I guarantee you'll be drinking heavily in a matter of days. .. and falling down drunk within a month.

Well Nick , its portrayed that way because AA is that way. Sexual harassment and sexual predation has been going on since bill wilson hit on the first new comer woman. I have not the time and enegergy to tell you all my horror stories but you can go to a blog called stop13stepin aa and read the early posts from April 2010 and get an ear full of 13 stepping BS that is still going on and is so very bad. A man recently stood up in a Meeting in Ohio and said that he raped an 8 year old and that he wanted to do things to the children of the women in the meeting that I can not write on WSJ page....its so disgusting. A toddler was molested IN AN AA meeting in Bellingham Washington, March 2013...google it. Its the tip of the iceberg. We are done being quiet. We are speaking up and speaking out!

mr m- I dont think so. ANother AA slogan being thrown around like its some jewel. Well, we know the truth about AA and we are sick and tired of the media giving AA lots of free pro AA press. SO now its our turn . ANd Ms Glaser and WSJ have the b**lls to print her point of view and the truth about how dangerous AA is right now. If someone wants to stop another way then AA, then its not your business.

Alcoholics Anonymous was founded 78 years ago and is still saving lives today. I wonder where Ms. Glaser's book, "Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control," will stand in 78 years and how many women it will have helped.

There have been many "Dr. Feelgood" types who have advanced their ideas on alcoholism. Though some drug treatments are successful to some degree, alcoholism is not able to be "cured" like smallpox, though one can be said to be "in recovery" from it. Alcoholism is essentially a disease of the spirit and unless that spirit can be reached and restored to health, drug treatments alone will only produce, at best, zombie-like compliance to behavioral norms.

To access the damaged spirit requires trust in one's fellows who have trod that same path, and some "higher power" figure to direct attention away from ones' self. My favorite alcoholic often repeats, "I may not be much, but I am all I think about." It keeps him honest.

Recovery requires constant vigilance, honest sharing with trusted fellow sufferers, and rigorous introspection. AA meetings are the best and the cheapest form of therapy for this disease and tattered copies of the Big Book will be dragged around for the next millennium at least.

Scott: Maybe so. But given that it made me laugh....am keeping the laugh and don't really care if some men 'feel' what is or is not appropriate for women. They don't get to choose...except in whacked out states when men are obsessed with governing women's bodies due to their Bible-belt beliefs. They remain unclear on separation of church and state...and their wives support them. Crazy as that sounds.

Alcohol does not discriminate. If you are an alcoholic, it does not matter how old you are, if you are male or female, if you make a lot of money or you are poor, if you are college educated or high school drop out or if you are white, black or yellow. A real alcoholic craves alcohol and becomes obsessed with the idea of drinking. It dominates the person's life and unless the alcoholic gets the necessary help the alcoholic will either end up in jail, in a insane asylum or dead.

Undoubtedly, alcoholism is one of the most misunderstood illnesses of our time. Society frowns upon the alcoholic because he or she usually leaves behind a path of destruction. In addiction, people become self absorbed, and the alcoholic is no different.

If a woman is an alcoholic, I hope she gets the help she needs. Life can be hell on earth in the late stages of an alcoholic.

Your question seemed rhetorical as if you knew the answer. Perhaps you don't think you do, but the questions you asked made it seem like you think that a large number of women are drinking to excess because they had abortions. I doubt that is the primary driver for increased alcohol abuse in women, but I don't have any empirical evidence.

The "we are only asking questions" game is commonly used by folks with no evidence. "Is Obama a spawn of Satan that has sworn allegiance to Hitler and Marx? We at FauxNews don't know, but we are only asking questions!"

So do you think people that are not swayed by the argument that a fetus is an independent life will be swayed by the argument that keeping a fetus until full term may prevent alcohol abuse later in life?

Data about abortions and later alcoholism/drug abuse in women might convince some people who are not *abortion fundamentalists* or *abortion absolutists*. There are people who consider themselves "pro-choice", but do not believe that the right to abortion should be absolute.

Abortion absolutists/fundamentalists believe that abortion is sacrosanct. They are against parental notification or any possible limitation of late-term abortion, and are constantly working to expand abortion access. You can't have a conversation about abortion with such people, except to agree with them 100%.

No, we did not say that we "already know the answer". The problem is, people who refuse to hear any criticism of abortion don't even want to ask the question. In fact, they want no questioning of abortion at all.

AA is always promoting itself through lots of ways. Hollywood gives it plenty of free promotion and does not depict AA in an authentic fashion.AA goes after school children, teens and now colleges. AA went after inmates for years. AA is imbedded in the court sytem. Thank you gabrielle Glaser for writing a great book with a sense of hunor on a topic that has not been discussed with a fresh aprroach by a woman with a critical eye towards AA. AA is not a Gold Standard anymore and yet everyone likes to think it is or was. Bill Wilson was a known womanizer. He was far from a saint as well.

Perhaps this is true, but it's worth noting that nobody's making money off of AA expansion, and attending is free, which is about the price point for many alcohol abusers.

AA is like "human development for dummies"- the 12 steps are basically the steps non-addicts (hopefully) take to reach maturity- recognize your problems, correct them, makes amends where possible, and try to help others.

Your remark is an flat out insult to the people who have adhered to the program. You can defile A all you want, but The 12 steps saved my life. When I write my book, I am sure negative people like you will find a way to dispute it. you need to get some help.

There's a relevant response. Mr. Simkatu, are you suggesting there are 1.2 million such instances of your example per year in the U.S., as with abortion? If not (and I suspect the rate of occurrence is far less), then what precisely is your point? Perhaps "bee stings", should we toss that data point in there as well?

I think women drink wine because it has the appearance of being something more akin to food, paired with specific dishes. Never mind that it contains alcohol! If one orders a vodka tonic instead of a glass of wine, and you have only one drink while your friends have glass after glass of wine, everyone still views you, the vodka drinker, as the potential alcoholic. Wine gets a pass.

"It doesn't take an advanced degree in gender studies to realize that this approach—which has worked well for millions of people—may not be perfect for women whose biggest problem is not an excess of ego but a lack of it."

The shear ego it requires to claim women don't have ego is astounding, and incredibly ironic. But given the mention of gender studies classes, it's understandable that this author has such a low opinion of women as a whole. Reading this article, you would think women can be nothing but victims. Alcohol affects women worst. They have so much harder a life than men that they need alcohol more... and not they a;; suffer from having no ego at all, and so suffer greater depression and anxiety than men (couldn't possibly have anything to do with the constant bombardment of feminists telling them how bad off they are, how they can only be victims and that "society" says they aren't allowed to be XYZ)

I didn't get the impression that women can be nothing but "victims" from this article. It's a biological fact that women are more physically vulnerable to the effects of alcohol. Stating this is not whining about how women are always "victims".

Women are also diagnosed with depression at a higher rate than men, and this has nothing to do with "bombardment of feminists telling them how bad off they are..." Saying that women have higher rates of depression doesn't mean the author has a "low opinion of women".

I read the entire article. I found it very enlightening. I am amazed by all of the men here who, after reading it, come to the comments section and blather on about their conventional views and advice completely oblivious to the subtle, valuable insights this article shared and that should have provoked thoughtful reflection. Really guys, in the light of new information...think different!

Fifty percent of Alcoholics Anonymous members are women today. It is just as effective for women as men. Using pop misunderstanding of "ego" to suggest housewives with a wine problem cannot be helped by A.A. Is not only incorrect, it is criminally misleading and may result in needless deaths of women who don't seek help there after reading it.

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